The present invention relates to a handpiece for surgical operation for crushing and removing foreign bodies within a biological histology or within a coeloma or a body cavity by ultrasonic vibration or oscillation.
As a surgical operating device for crushing or cutting and separating or amputating a biological histology by ultrasonic vibration, a surgical operating device is known whose object is soft histology or tissue for ophthalmology in which lenses hardened by a cataract are crushed, drawn or evacuated and removed, and one is known for general surgery in which a tumor and a hematoma generated in brain, spine, digestive organ and the like are crushed, drawn and removed. Further, in recent years, an ultrasonic operating device has been utilized which can cut and separate or isolate hard histology by ultrasonic vibration.
Furthermore, among various kinds of manipulations and devices developed for performing medical treatment by minimal invasion and non-invasion, an operation for extracting a gallbladder by the use of a laparoscope is now in wide use, particularly for digestive organ,surgery because recovery is fast and hospital stays are short so that rehabilitation can also be fast, pain after operation is reduced, the operative wound created in the surgery is extremely small and the like, since there is less in operational invasion as compared with ventrotomy operation.
The operation is such that a pneumoperitoneum is made to the interior of the peritoneal cavity by carbonic acid gas or the like without ventrotomy, and a trocar is used to insert an endoscope, forceps, an electrocautery or the like into the interior of the peritoneal cavity, and the gallbladder is extracted under the field of vision of the endoscope. A point thereof is that a cystic duct and a cystic artery are peeled off or ablated safely and accurately from a Calot's triangle, clipping is made to the cystic duct and the cystic artery to cut the latter, and a cystic fundus is ablated from a liver bed section to grasp or grip the gallbladder by the forceps, to thereby remove the cystic fundus out of the body.
Moreover, there are caused the following problems and the like. That is, if an attempt is made to apply the operation under the endoscope to all cases of cholelithiasis, the use of ordinary grasper causes macroapoplexy from artery and the liver bed section, and makes it difficult to fix the cystic duct and the cystic artery, and the like, depending upon conditions such as inflammatory degree of the gallbladder, a position of gallstone, configuration of the cystic duct, the cystic artery and the like, age of a patient and the like. There is a danger that switching must be made to ventrotomy operation during the operation. On the contrary, counterplan or countermeasures are taken such as an improvement in hemostatic effects due to an improvement of configuration of a forward end of the electrocautery, hemostasis by the use of a laser surgical knife, or the like. However, since a mechanical tearing force of forceps is used for the visual field disturbance due to smoke and for peeling or separation of the cystic duct and the cystic artery, this is not basic bleeding prevention.
In view of the above, trials are made such that a surgical operating device due to ultrasonic vibration, capable of selectively preserving or retaining a resilient or elastic body such as blood vessels or the like is used to carry out these operations.
However, there are fears that, since the operation is one under reduced or narrow visual field of the endoscope, it is impossible to pass the handpiece from one hand to the other to change the inserting position dissimilarly to the ventrotomy operation, and irrigation liquid jetted from a tip section at a forward end of a handpiece is applied to lenses, since a distance between an objective lens of the endoscope and a portion to be operated is short such as few cm.
For example, as shown in FIGS. 11A and 11B, in a case where a cystic duct 36 connected to a gallbladder 37 is peeled off or separated, an inserting direction of a tip 100 at a forward end of a handpiece is limited or restricted by a direction of a trocar which pierces into a laparotomy from the outside of the body. Accordingly, it is difficult to separate a fundus of the cystic duct 36. Moreover, under a condition illustrated in FIGS. 12A and 12B, irrigation liquid jetted from a clearance or gap between a tip cover 101 and a tip 100 by vibration of the tip 100 scatters over a wide range, resulting in clouding of the lenses of the endoscope.
Further, in a case of the operation under the endoscope, a vibrator section such as a tip or the like which is inserted into the body is lengthened. For this reason, it is difficult to judge as to whether or not the irrigation liquid is surely or reliably supplied up to the forward end of the tip. In a case where the tip is vibrated under a condition that the irrigation liquid is insufficient, there is a fear that the irrigation liquid of high temperature is jetted so that tissues are damaged. Thus, countermeasures are required.